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Generic Name: diclofenac (dye KLOE fen ak) Brand Names: Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex, Voltaren What is diclofenac? Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). This medicine works by reducing substances in the body that causepain and inflammation. Diclofenac is used to treat mild to moderate pain, or signs and symptoms of osteoarthritisor rheumatoid arthritis. The Cataflam brand of this medicine is also used to treat menstrual cramps. Diclofenac oral powder (Cambia) is used totreat a migraine headache attack. Cambia will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks. Important information You should not use diclofenac if you have a history of allergic reaction to aspirin or NSAIDs (non-steroidal anti-inflammatory drugs). Diclofenac may increase your risk of fatal heart attack or stroke, especially if you use it long term or have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG). Slideshow: Drug Treatment for Rheumatoid Arthritis - What Are Your Options? Diclofenac may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are taking this medicine. Before taking this medicine Do not use Cambia to treat a clusterheadache . To make sure diclofenac is safe for you, tell your doctor if you have: • heart disease, high blood pressure, or history of heart attack, stroke, or blood clot; • a history of stomach ulcers or bleeding; • liver or kidney disease; • asthma; • polyps in your nose; • a bleeding or blood clotting disorder; or • if you smoke. FDA pregnancy category D. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Taking diclofenac during the last 3 months of pregnancy may harm the unborn baby. Do not take diclofenac during pregnancy unless your doctor has told you to. See also: Pregnancy and breastfeeding warnings (in more detail) It is not known whether diclofenac passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine. Do not give this medicine to a child younger than 18 years old without medical advice . How should I take diclofenac? Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended. Different brands of diclofenac contain different amounts of this medicine, and may have different uses. If you switch brands, your dose needs may change. Follow your doctor's instructions about how much medicine to take. Ask your pharmacist if you have any questions about the brand of diclofenac you receive at the pharmacy. Do not crush, chew, or break an extended-release tablet or delayed-release tablet. Swallow it whole. Dissolve Cambia in 1 to 2 ounces of water. Do not use any other type of liquid. Stir this mixture and drink all of it right away. Cambia works best if you take it on an empty stomach. Call your doctor if your headache does not completely go away after taking Cambia. Do not take a second dose of Cambia without your doctor's advice. If you use diclofenac long-term, you may need frequent medical tests at your doctor's office. Store at room temperature away from moisture and heat. What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking diclofenac? Ask a doctor or pharmacist before using any cold, allergy, or pain medication . Many medicines available over the counter contain aspirin or other medicines similar to diclofenac. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen. Avoid drinking alcohol. It may increase your risk of stomach bleeding. Diclofenac side effects Get emergency medical help if you have any of these signs of an allergic reaction to diclofenac: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using diclofenac and call your doctor at once if you have: • severe nausea; • sudden or severe stomach pain, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds; • flu symptoms, pale skin , unusual tiredness; • swelling, rapid weight gain; • worsening asthma (wheezing, chest tightness, trouble breathing); • heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating ; • signs of a stroke--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance; • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); • signs of a kidney problem--little or no urinating, painful or difficult urination, swelling in your feet or ankles; or • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling. Older adults may be more likely to have serious stomach problems while taking medicine that contains an NSAID. Common diclofenac side effects may include: • heartburn, indigestion, gas, stomach pain, nausea, vomiting; • diarrhea, constipation; • headache, dizziness, drowsiness; • itching, increased sweating; • increased blood pressure; or • swelling, pain in your arms or legs. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. See also: Side effects (in more detail) Diclofenac dosing information Usual Adult Dose for Osteoarthritis: Diclofenac: 50 mg orally 2 to 3 times a day or 75 mg orally twice a day. Doses greater than 150 mg/day are not recommended for osteoarthritis. Extended-release: 100 mg orally once a day. Usual Adult Dose for Ankylosing Spondylitis: Diclofenac Sodium: 25 mg orally 4 times a day. An additional 25 mg dose may be administered at bedtime, if necessary. Usual Adult Dose for Dysmenorrhea: Diclofenac Potassium: 50 mg orally 3 times a day. In some patients an initial dose of 100 mg of diclofenac potassium, followed by 50 mg doses, will provide better relief. After the first day, the total daily dose should generally not exceed 150 mg. Diclofenac Potassium liquid filled capsules (Zipsor) are only approved by the FDA for mild to moderate acute pain. The dosage for this product is 25 mg orally 4 times a day. For mild to moderate acute pain in adults: Diclofenac marketed as Zorvolex : Zorvolex is not interchangeable with other formulations. Other formulations contain a salt of diclofenac (i.e., diclofenac potassium or sodium), while Zorvolex contains the free acid. Recommended dose: 18 or 35 mg orally 3 times a day -Taking Zorvolex with food may cause a reduction in effectiveness compared to taking on an empty stomach. Usual Adult Dose for Pain: Diclofenac Potassium: 50 mg orally 3 times a day. In some patients an initial dose of 100 mg of diclofenac potassium, followed by 50 mg doses, will provide better relief. After the first day, the total daily dose should generally not exceed 150 mg. Zipsor is only approved by the FDA for mild to moderate acute pain. The dosage for this product is 25 mg orally 4 times a day. For mild to moderate acute pain in adults: Diclofenac marketed as Zorvolex : Zorvolex is not interchangeable with other formulations. Other formulations contain a salt of diclofenac (i.e., diclofenac potassium or sodium), while Zorvolex contains the free acid. Recommended dose: 18 or 35 mg orally 3 times a day -Taking Zorvolex with food may cause a reduction in effectiveness compared to taking on an empty stomach. Usual Adult Dose for Rheumatoid Arthritis: Diclofenac: 50 mg orally 3 to 4 times a day or 75 mg orally twice a day Extended-release: 100 mg orally once a day Doses greater than 225 mg/day are not recommended for rheumatoid arthritis. Usual Adult Dose for Migraine: For acute treatment of migraine without aura: Cambia: Mix one packet (50 mg) with 1 to 2 ounces (30 to 60 mL) water in a cup and drink immediately. Usual Pediatric Dose for Pain: Children: 2 to 3 mg/kg/day orally in divided doses 2 to 4 times daily Maximum dose: 200 mg daily. What other drugs will affect diclofenac? Ask your doctor before using diclofenac if you take an antidepressant such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed easily. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with diclofenac, especially: • a blood thinner such as warfarin (Coumadin, Jantoven); or • steroid medicine (prednisone, dexamethasone, methylprednisolone, and others). This list is not complete. Other drugs may interact with diclofenac, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.